When it comes to fluoride, we know we’re largely preaching to the choir here, while also hoping that the choir keeps getting larger – and louder! – until we all finally agree that the stuff has no business in our bodies and that there are better ways of keeping teeth healthy and whole.
Among the most recent? A review and meta-analysis published last month in Caries Research, which looked at the effectiveness of fluoride varnish in preschoolers. This treatment involves painting the teeth with fluoride. It’s cheap and easy to provide, but does it work?
After analyzing 20 studies from more than a dozen countries, the authors could only conclude that the fluoride varnish didn’t seem to help much. Kids still developed new cavities, whether they got the varnish or not.
Our study highlighted that increasing the exposure to professionally applied fluoride through varnish made hardly any difference for the risk of developing new caries in children.
Yet the ADA and CDC continue to recommend fluoride varnish as a “safe and effective” topical for preventing decay, despite such evidence. In fact, one study of intensive varnish use found not only that it didn’t prevent decay in the front teeth; decay in the back teeth actually increased.
What does help, according to the literature, has nothing to do with fluoride. As the authors write,
Despite the widespread exposure to fluoride, the burden and the prevalence of dental caries have remained relatively stable between 1990 and 2015 [Kassebaum et al., 2017]. In the present review, a large number of the children developed new dentine caries lesions, regardless of FV use. The cause of dental caries, and of the increase in caries with age, is the excessive exposure to sugar, not the lack of fluoride exposure [Sheiham and James, 2015; Simón-Soro and Mira, 2015]. Sugar reduction is urgently needed as fluoride does not halt caries when sugar intake is high (≥10%) [Sheiham and James, 2014, 2015].
In other words, you can’t have your cake and no cavities, too.
Quitting the sugar – which includes not just the sweet stuff but all fermentable carbs (think bread, pasta, and others foods made from flour or otherwise processed grains) – will do more for preventing caries than any amount of fluoride could ever do.
Image courtesy of Dave Buchwald